The effect of post-operative NSAID administration on bone healing after elective foot and ankle surgery

Abstract

Background: Post-operative pain is a common concern following elective foot and ankle surgery. NSAIDs used for pain relief have led to bone-healing complications in animal models and in vitro studies. This retrospective study examined the rate of bone-healing complications in post-surgical patients using NSAIDs.

Methods: Participants underwent elective foot surgeries between January 2016 and May 2018. Radiographs were used to identify bony nonunion at osteotomy sites 12 weeks post-surgery.

Results: Two-hundred thirty-two patients were evaluated; 59 (25.43%) were prescribed ibuprofen, 62 (27%) ketorolac, 15 (6.47%) acetaminophen, and 92 (40%) hydrocodone-acetaminophen. Two-hundred and twelve (91.38%) patients exhibited radiographic evidence of osseous union at 12 weeks and 20 (8.62%) had radiographic evidence of non-union of the osteotomy sites. There was no significant relationship between NSAID use and osseous non-union (p<0.05).

Conclusions: Short-term use of oral ibuprofen and ketorolac in the post-operative period was not associated with bony non-union.

Keywords: Delayed union; Ibuprofen; Inflammation; Ketorolac; Non-union; Pain.